Provider Demographics
NPI:1588667760
Name:CHEROKEE NATION
Entity Type:Organization
Organization Name:CHEROKEE NATION
Other - Org Name:CHEROKEE NATION EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-453-5025
Mailing Address - Street 1:PO BOX 977
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74465-0977
Mailing Address - Country:US
Mailing Address - Phone:918-453-5648
Mailing Address - Fax:
Practice Address - Street 1:22114 S BALD HILL RD
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-1519
Practice Address - Country:US
Practice Address - Phone:918-458-5403
Practice Address - Fax:918-458-4488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKEMS2633416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100729250BMedicaid
OK590005278OtherRAILROAD MEDICARE
OK590005278OtherRAILROAD MEDICARE